Resp Revision

Question 1

what sign may be seen on a cross-sectional image of the lung in a pt with bronchiectasis and why?

Answer 1

a signet ring sign
occurs when the dilated bronchus is and accompanying pulmonary artery are seen in cross section as should both normally be the same size but in this disease bronchus is markedly dilated.

Question 2

what is the mechanism by which R sided heart failure can develop in a COPD patient?

Answer 2

hypoxic pulmonary vasoconstriction
alveolar hypoxia and resp acidosis stimulate pulmonary arterial vasoconstriction and hypoxaemia stimulates erythrocytosis. Increase pulm. vascular resistance, blood volume and viscosity all contribute to pulmonary HTN, increasing the strain on the RV so it hypertrophies with LT pulmonary HTN.

Question 3

name given to a type of lung tumour which can cause Horner’s syndrome and explain why the symptoms of Horner’s are produced.

Answer 3

Pancoast tumour= apical lung tumour
Horner’s: partial ptosis, miosis, hemifacial anhidrosis
result of invasion into the cervical sympathetic plexus, which disrupts the sympathetic innervation to the eye.
partial ptosis- loss of sympathetic innervation to the superior tarsal muscle which elevates the upper eyelid alongside levator palpebrae superioris.
miosis- loss of S.innervation to the dilator pupillae muscle, and P.innervation to sphincter pupillae remains.
hemifacial anhidrosis- loss of S.innervation to sweat glands on same side of face as the lesion.

Question 4

duration of acute and chronic coughs?

Answer 4

acute-less than 3 wks

chronic- more than 8 wks

Question 5

most common causes of a chronic cough- lasting more than 2 mnths, in a NON-smoker with a normal CXR?

Answer 5

GORD
chronic sinus disease with postnasal drip
ACEIs

Question 6

red flag symptoms assoc. with cough?

Answer 6

weight loss
fever
chest pain
haemoptysis
breathlessness

Question 7

how does cough syncope occur?

Answer 7

may result from raised intrathoracic pressure impairing venous return to the heart, reducing cardiac output.

Question 8

most common cause of dysphonia (hoarse voice)?

Answer 8

laryngitis

Question 9

define stertor

Answer 9

a resp. sound producing muffled speech (‘hot potato’), which occurs with nasopharyngeal or oropharyngeal blockage e.g. quinsy.

Question 10

type of sputum in pneumococcal pneumonia?

Answer 10

rusty red

as in early disease, pneumonic inflammation causes red cell lysis.

Question 11

if frothy pink sputum occurs over wks rather than in an acutely breathless pt, what disease might this suggest?

Answer 11

alveolar cell cancer

Question 12

cause of increased vocal resonance?

Answer 12

consolidation-pneumonia

Question 13

causes of dull percussion note?

Answer 13

pulmonary consolidation
pulmonary collapse
severe pulmonary fibrosis

Question 14

characteristic of pt on clinical examination that distinguishes between pneumothorax and tension pneumothorax?

Answer 14

tension=haemodynamic instability- decrease BP and increase HR

Question 15

causes of yellow sputum?

Answer 15

acute bronchopulmonary infection

asthma (eosinophils)

Question 16

causes of green sputum?

Answer 16

longer-standing infection:
pneumonia
bronchiectasis
CF
lung abscess

Question 17

cause of clear, grey mucoid sputum?

Answer 17

chronic bronchitis/COPD

Question 18

what is Kussmaul respiration?

Answer 18

hyperventilation with deep sighing respirations

occurs in metabolic acidosis e.g. DKA, acute renal failure, lactic acidosis and salicylate and methanol poisoning.

Question 19

importance of examining for chest wall tenderness?

Answer 19

presence indicates Px of chest pain unlikely to be due to a cardiac problem